Tuberculosis continues to pose a threat to public health, and resistance to commonly used antibiotics is an increasingly prevalent problem in efforts to control this disease. Thus, there is a great need to develop new drugs and therapeutic strategies. Mycobacteria display intrinsic resistance to antibiotics due to the low permeability of the mycobacterial cell wall and active efflux of antibiotics. An understanding of drug efflux systems role in intrinsic antibiotic resistance and their regulation will lead to new therapeutic approaches to TB since inhibition of these intrinsic systems may improve the efficacy of current drugs and shorten treatment time. Previously we showed that ubiquitin-derived peptides (Ub-peptides) contribute the mycobactericidal repertoire of macrophages (Alonso et al., 2007;Purdy et al., 2009). Our first objective is to better understand the bactericidal actions of these peptides. Initial studies indicate that Ub-peptides behave like antimicrobial peptides to impair mycobacterial membrane function. Mycobacterium tuberculosis (Mtb) has co-evolved with the human immune response and likely possesses resistance mechanisms to sub-lethal concentrations of host antimicrobial compounds. In modern disease, these systems may provide intrinsic resistance to antibiotics. To identify Mtb intrinsic resistance mechanisms, two complementary approaches were taken using mycobactericidal Ub-peptides as a tool. 1.) We directly identified ABC and MFS transporter mutants more susceptible to treatment with Ub-peptides in a transposon mutant screen. 2.) The expression profile of Mtb exposed to Ub-peptides was analyzed. Ten percent of Ub-peptide regulated genes encoded predicted membrane proteins including ATP Binding Cassette (ABC) or Major Facilitator Superfamily (MFS) transport systems. These differentially expressed genes alter the bacterial response to the presence of antimicrobial peptides and antibiotics. To show this we acquired Mtb mutants that lack ABC and MFS transporters and found that they are more susceptible to antimicrobial peptides and antibiotics. Our working hypothesis is that Ub- peptides are host antimicrobial peptides and that Mtb ABC and MFS membrane transport systems contribute to Mtb intrinsic antimicrobial resistance and virulence. The long-term goal of this work will direct therapeutic targeting of these membrane transport systems to increase the inherent sensitivity of Mtb to host antimicrobial compounds and antibiotic treatment. Our aims are the following: 1) We will characterize the mechanism of Ub-peptide action. 2) To better understand intrinsic resistance of Mtb we will define the role of the ABC transporters Pst and Rv0986-Rv0987, and the MFS transporters Rv1634, and Rv3239c in the intrinsic resistance of Mtb. 3) We will determine if these ABC and MFS transporters contribute to M. tuberculosis virulence through macrophage survival assays and mouse infections. These studies will expand our knowledge of M. tuberculosis intrinsic resistance to antimicrobial Ub-peptides and antibiotics, and will identify targets for future drug therapy approaches. PUBLIC HEALTH RELEVANCE: Tuberculosis continues to pose a threat to public health, and resistance to commonly used antibiotics is an increasingly prevalent problem in efforts to control this disease. Our efforts are now focused on understanding how Ub-peptides kill mycobacteria and characterizing mycobacterial mutants with altered susceptibility to Ub- peptides. We have isolated mycobacterial mutants in ABC and MFS transporters that are hyper-susceptible to Ub-peptides. We propose that these transporters, which provide resistance to host antimicrobials and antibiotics, are required for virulence.